Community Medical Group
Community Medical Group
Job Description
Credentialing Specialist
TheCredentialingSpecialistis responsibleforallaspectsoftheprivileging andcredentialing processforthe health careprovider.The Specialistwill processesapplications, verify information,researchapplication details, andassure processesareinaccordancewithCMG’s Policies and Procedures.TheSpecialistwillprovideconsistent, accurate,andtimelycredentialingsupport,enhancing theorganization’sabilitytoprovideprofessionalservices. Workincludes theaccurate,timelyanddocumentedverificationoftheinformationprovidedbytheapplicantand maintenanceofthehighly confidential credentialingrelatedfiles.
ESSENTIALFUNCTIONS/PERFORMANCEEXPECTATIONS:
Theessentialfunctionsandperformance expectations describedherearerepresentativeofthoseanemployee encounterswhileperformingthebasicfunctionsofthis job. Anemployeemayberequiredtoperformother functionsas assigned,whicharenotlisted.
I. JobSpecificFunctions/PerformanceExpectations
A. Job Specific Functions/Performance Expectations
1. Responsible for primary source verification for medical school, residency, fellowship, NPDB, state and federal
sources.
2. Assists with the on-boarding process for physicians and mid-level candidates.
3. Coordinates the credentialing and privileging processes for physicians and mid-level providers.
4. Processes provider credentialing applications in accordance with accreditation standards, regulatory
requirements, and policies and procedures.
5. Examines, researches, enters data, files, and gathers all information necessary to process information
received from providers to support the credentialing process.
6. Maintains compliance with documentation standards for verification of employee credentialing
requirements, including but not limited to licenses, certifications, registrations, permits, educational degrees,
association memberships and any related electronic systems and software.
7. Serves as staff support for the Credentialing Committee.
8. Responsible for the maintenance and accuracy of electronic credentialing files in Cactus
system.
9. Verify, research, and respond to telephone inquiries and written inquiries, from providers and other
sources, pertaining to provider participation and credentialing status in a professional and courteous
manner.
10. Maintain all additions, terminations, and changes to all plans as appropriate.
11. Processes with payers and practices, all opt-in forms from physicians and providers for participation in CMG payer contracts.
12. Resource to CMG practices regarding physician and provider enrollment questions and issues.
Community Medical Group
Credentialing Specialist Job Descriptionpage 2
II. GeneralFunctions/PerformanceExpectations
A. Time Management:
Manages, plans and adjusts work time to effectively completework responsibilities. Completestasks and assignmentsby scheduled duedates;allocatestime to various tasks and assignments inaccordance with priorities; informs supervisor when scheduleproblems occur.
B. Attendance:
Adheresto standardsof attendance,punctualityand time off. When absentorlate, notifies supervisorin a timely mannerbeforestartof scheduledshift.
C. Customer Service:
Adheresto customerservice standards by meeting theneedsof internal andexternal customersthrough professionalinteractions.
D. Teamwork:
Interactswell with coworkersand supervisor in an appropriateand reliablemanner andcontributes to the team effort. Coordinates activities appropriatelyandeffectively and seeks assistance,guidanceand counselfrom others as needed. Shows sensitively to andconcern for the interestsandneeds ofothers. Negotiateswith others.
E. Communication:
Speaks clearly,concisely and using wordseasily understood;exchanges ideas with others and listens with the intent to understand.Writes for the appropriateaudiencewithclear and appropriate skill.
F. Quantity of Work:
Generateswork in quantities sufficient tomeet theneeds andexpectationsof the position and organization.
G. Quality ofWork:
Completeswork thoroughly,accurately,neatlyand concisely.
H. Attitude:
Assumes responsibility for workwithout being told; Willing to accept assignments. Contributes toa positive organizational cultureand morale. Works toreduceconflict andestablish goodworking relationships with others.
I. Professionalism:
Maintains positive, constructive,collaborative, cooperative, professional,friendly and respectfulworking relationships with coworkersand supervisor. Keepsbehaviors, communicationsand otheroutwardexpressions regardingCHC in a positive manner. Meets the expectations ofdressand appearance standards.
Community Medical Group
Credentialing Specialist Job Descriptionpage 3
Knowledge, Skills and Abilities
- Reads, speaks, understandsand writes proficiently in English.
- Works independentlyand is self-directed.
- Effectivepresentationskills.
- Relatesand interacts with staff at all levelsof theorganization.
- Representsthe organization in a professional andeffective mannertothe community.
- Works effectivelyin a teamenvironment.
- Organizes, prioritizes, and coordinates multiple activitiesand tasks.
- Workswith initiative, energyandeffectiveness in afast-paced environment.
- Produceswork in high quantity and quality.
- Problem-solves with creativity and ingenuity.
- Proficiency inthe use of MicrosoftOffice applications; Word, Excel,Outlook and PowerPoint.
- Communicateseffectivelybothorally andin writing.
- Knowledge ofprovider credentialingcriteria and processes in accordancewith NCQA standards, NPDB guidelines andgeneral licensing regulations.
- Completesmandatoryeducation and trainingcoursesina timely manner. Seeksoutadditional educational opportunitiesto continuouslyimprove skills, educationand knowledge.
Qualifications:
- At least 3 years of experience in provider credentialing
- Associate Degree or two years of college preferred
- NAMSS certification as a Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS) or actively seeking certification and ability to become certified within one year.
Contact Information:
Donna Consiglio
203-687-4422 X102